Bergmann A, Schulze J, Hübner D, Weizel A, Julius U, Kreuzer J
Medizinische Klinik III,Universitätsklinik der TU Dresden, München, Germany.
Eur J Epidemiol. 2003;18(5):407-11. doi: 10.1023/a:1024232304665.
Current studies on secondary prevention of cardiovascular events (CARE, LIPID, 4S) illustrate the necessity of an effective lipid-lowering therapy. An important part of secondary prevention is the prompt measurement of lipids following an infarct, to be able to start therapy as quickly as possible.
This study should show the general situation in the prescription of lipid-lowering drugs in patients with acute myocardial infarction (MI) and if there are gender differences in therapy and in the lipid parameters. The second aim was to determine the therapeutical conclusions for secondary prevention made in-hospital in patients with heart attacks.
Post-infarct lipid parameters (total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG) were examined in 5361 patients within 24 hours following an acute MI. Lipid parameters from 576 patients were measured again after 1 week.
80.1% of men under examination and 81.9% of the women had suffered from their first MI. Only 9% of all patients were already under lipid-lowering therapy before the MI. After the MI TC and LDL-C levels decreased significantly in a time-dependent manner. Around 50% of patients received lipid-lowering drug, or the recommendation of one, during their hospital stay.
The range of TC values of the patients examined was comparable to those in the CARE and the 4S secondary prevention studies. It can therefore be assumed that the results of these studies are also applicable to Germany. Nevertheless, according to existing data, therapy with lipid-lowering drugs is currently unsatisfactory, even in secondary prevention.
目前关于心血管事件二级预防的研究(CARE、LIPID、4S)表明了有效降脂治疗的必要性。二级预防的一个重要部分是在梗死发生后迅速测量血脂,以便能够尽快开始治疗。
本研究应展示急性心肌梗死(MI)患者降脂药物处方的总体情况,以及治疗和血脂参数方面是否存在性别差异。第二个目的是确定心脏病发作患者在医院内进行二级预防的治疗结论。
在5361例急性心肌梗死后24小时内检查梗死后期血脂参数(总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG))。1周后再次测量576例患者的血脂参数。
接受检查的男性中有80.1%、女性中有81.9%发生的是首次心肌梗死。所有患者中只有9%在心肌梗死前已接受降脂治疗。心肌梗死后,TC和LDL-C水平随时间显著下降。约50%的患者在住院期间接受了降脂药物治疗或得到了使用降脂药物的建议。
所检查患者的TC值范围与CARE和4S二级预防研究中的相当。因此可以假设这些研究结果也适用于德国。然而,根据现有数据,即使在二级预防中,目前降脂药物治疗也不尽人意。